Notice of Privacy Practices
Effective September 1, 2010
6701 North Charles street
Baltimore, mD 21204
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This notice describes how health
information about you may be used
and disclosed and how you can get
access to this information.
Please review it carefully.
If you have any questions, please contact our
Privacy Officer at the address or phone
number listed at the end of this Notice.
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We take the privacy of your health information seriously and we are
committed to protecting your health information. This Notice applies
to all records of your care that we maintain, which contain your
protected health information (PHI). Protected health information is
medical information that identifies you or may provide a basis for
identifying you. Your personal doctor may have different policies
or notices regarding the doctor’s use and disclosure of your health
information created in the doctor’s office. This Notice is provided
to tell you about the duties and practices of GBMC Healthcare with
respect to your health information. We are required by law to provide
you with this Notice, and we are required to follow the terms of the
Notice that is currently in effect.
Who This Notice Applies To
This Notice describes the privacy practices of those individuals or
entities listed below:
• Greater Baltimore Medical Center (GBMC) and all affiliated
• Gilchrist Hospice Care.
In addition, these individuals or entities may share PHI with each
other for treatment, payment or healthcare operation purposes
described in this Notice.
Changes to this Notice
We reserve the right to change this Notice. We reserve the right to
make the revised Notice effective for health information we already
have about you as well as any information we receive in the future.
How we may use and disclose your health information
The following categories describe and give examples of the different
ways that we may use and disclose your health information. All of the
ways we are permitted to use and disclose your information will fall
within one of these categories.
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We may use PHI about you to provide you with treatment. We
may disclose your PHI to doctors, nurses, aides, technicians or
members of the workforce (including contracted employees),
pharmacists, suppliers of medical equipment or other healthcare
professionals who are involved directly or indirectly with your
care. For example, we may use and disclose your PHI for treatment
purposes if we need to request the services of an outside
laboratory to perform blood tests that are more extensive than
those that would be performed by our in-house laboratory.
We may use and disclose your PHI for payment purposes. We
will bill and collect for the treatment and services we provide
to you. We may send your PHI to an insurance company or
third party for payment purposes including a collection service.
For example, we may use and disclose your PHI for payment
purposes if we contact your insurance company in order to
obtain approval for an admission or procedure.
• Healthcare Operations
We may use and disclose your PHI for healthcare operations.
These uses and disclosures are necessary to make sure that you
receive competent, quality healthcare and to maintain and
improve the quality of healthcare that we provide. For example,
we may use your PHI for performance improvement activities,
which would contribute to our mission of providing medical
care and service of the highest quality to each patient.
• Health Information Exchanges
We participate in the Chesapeake Regional Information System
for our Patients, Inc. (CRISP), a state-wide health information
exchange. As permitted by law, your health information will be
shared among several health care providers or other health care
entities in order to provide faster access, better coordination of
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care and assist providers and public health officials in making
more informed decisions. This means we may share information
we obtain or create about you with outside entities (such as
doctors’ offices, labs, or pharmacies) or we may receive
information they create or obtain about you (such as medical
history or billing information) so each of us can provide better
treatment and coordination of your healthcare services. You
may “opt-out” and prevent searching of your health information
available through CRISP by calling 1-877-952-7477 or completing
and submitting an Opt-Out form to CRISP by mail, fax or
through their website at www.crisphealth.org. Even if you
opt-out, a certain amount of your information will be retained
by CRISP and your ordering or referring physicians, if
participating in CRISP, may access diagnostic information
about you, such as reports of imaging and lab results.
• Permitted Uses without Prior Authorization
We may use or disclose your PHI without your prior authorization
for several other reasons. Subject to certain requirements,
we may give out health information about you without prior
authorization for public health purposes, abuse or neglect
reporting, health oversight audits or inspections, research studies
(chart review only), funeral arrangements and organ donation,
worker’s compensation purposes, and emergencies. We also
disclose health information when required by law, such as in
response to a request from law enforcement in specific circumstances,
or in response to valid judicial or administrative orders.
• To Avert a Serious Threat to Health or Safety
We may use and disclose your necessary PHI when we believe
it is necessary to prevent a serious threat to your health and
safety or the health and safety of the public or another person.
Any disclosure, however, would only be to someone able to help
prevent or lessen the threat or to law enforcement authorities in
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• Specialized Government Functions
If you are in the military or are a veteran, we will disclose your
health information as required by command authorities. We
may disclose health information to authorized federal officials
for national security purposes, such as protecting the President
of the United States or for authorized intelligence operations.
• Correctional Institution and Other Law Enforcement Custodial
We may disclose to a correctional institution or law enforcement
official having lawful custody of an inmate or other individual,
PHI about the inmate or individual if the correctional institution
or law enforcement authority makes certain representations to
us, proving that the disclosure of the PHI is necessary.
• Treatment Alternatives, Appointment Reminders and Health-
We may use and disclose your PHI to tell you about or recommend
possible treatment alternatives or health-related benefits
or services that may be of interest to you. Additionally, we may
use and disclose your PHI to provide appointment reminders. If
you do not wish us to contact you about treatment alternatives,
health-related benefits or appointment reminders, you must
notify the Privacy Officer in writing and state from which of
those activities you wish to be excluded.
• Fundraising Activities
We may use certain information (e.g., name, address, telephone
number, dates of service, age and gender) to contact you in an
effort to raise money for our operations. We may also provide
this information to our related foundation for the same purpose.
The money raised will be used to expand and improve the services
and programs we provide to the community. We do not sell the
information that we are allowed by law to receive. If you do not
want us to contact you for fundraising efforts, you must notify
the Privacy Officer in writing.
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• Patient Information Directory
We may include certain limited information about you in our
patient information directory. This information may include
your name, location in the facility, your general condition (e.g.,
stable, guarded, serious and critical) and your religious affiliation.
The directory information, except for your religious affiliation,
may also be released to people who ask for you by name. Your
religious affiliation may be given to a member of the clergy,
such as a priest, minister or rabbi even if they do not ask for
you by name. You will be asked at the time of registration if you
would like to be included in our patient information directory.
If you choose not to be listed in our patient information
directory, callers and visitors who ask for you by name
will be told, “There is no one listed by that name.” However,
if you do choose not to be listed in our patient information
directory but still wish to receive visitors or calls then you must
release your room number and phone number yourself. We will
gladly direct visitors to your room as long as you have provided
them with that information prior to them entering our facility.
• Individuals Involved in Your Care or Payment for Your Care
We may release health information about you to a family
member, other relative or any other person identified by you
who is involved in your healthcare with your permission. We
may also give information to someone who helps pay for your
care. We may also tell your family, friends, personal representative
or other person responsible for your healthcare your condition
while you are at the facility.
• Third Parties
We may disclose your PHI to third parties with whom we
contract to perform services on our behalf. If we disclose your
information to these entities, we will have an agreement with
them to safeguard your information.
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Other Uses of Health Information
Other uses and disclosures of health information not covered by
this Notice or the laws that apply to us will be made only with your
written authorization. Examples of PHI disclosures that require
your authorization include disclosures of psychotherapy notes and
disclosures for purposes of marketing, among others. If you provide
us authorization to use or disclose your PHI, you may revoke that
authorization, in writing, at any time. If you revoke your authorization,
we will no longer use or disclose PHI about you for the reasons
covered by your written authorization. You understand that we are
unable to take back any disclosures we may have already made under
Your Rights Regarding Your Health Information
All request forms relating to your rights as mentioned below may be
obtained from the Medical Records department at the treating facility.
You have the following rights regarding health information we
maintain about you:
• Right to See and Copy Your Health Record
You have the right to review or get a copy of your health record.
Please make your request in writing to the Medical Records
department where you received treatment. If you request a copy
of the information, we may charge a fee for the costs of copying,
mailing or other supplies associated with your request.
• Right to Amend (Update) Your Health Record
If you believe that a piece of important information is missing
from your health record, you have the right to ask us to modify,
but not delete, your health and/or billing information for as
long as the information is kept by us. You must submit your
request in writing and you must provide a reason that supports
your request. We will inform you of our decision in writing. We
may deny your request if you ask us to amend information that:
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• Was not created by us, unless the person or entity that
created the information is no longer available to make
• Is not part of the health information kept by or for us;
• Is not part of the information which you would be
permitted to inspect and copy; or
• Is accurate and complete.
• Right to an Accounting (List) of Disclosures We Have Made
You have the right to a list of disclosures we have made of your
health information. The list will not contain disclosures made
for purposes of treatment, payment or healthcare operations.
It will not contain disclosures that were authorized by you and
certain other disclosures excluded by law. You must submit
a written request to obtain a copy of this disclosure list. Your
request must state a time period, which may not be longer than
six years and may not include dates before April 14, 2003. The
first list you request within a 12-month period will be free. For
additional lists, during such 12-month period, we may charge
you for the costs of providing the list. We will notify you of the
cost involved, and you may choose to withdraw or modify your
request at that time.
• Right to Request Confidential Communications
You have the right to request that health information about
you be communicated to you in a confidential manner. For
example, you may ask that we call your cell phone with
appointment reminders instead of your home phone. To request
confidential communications, you must make your request in
writing. We will not ask you the reason for your request. We
will accommodate all reasonable requests. Your request must
specify how or where you wish to be contacted. We will inform
you of our decision in writing.
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• Right to Request Restrictions
You have the right to request that we limit how we use and
disclose your health information. We are legally required to
accept certain requests to not disclose health information to
your health plan for payment of healthcare operations purposes
if you have paid in full out of your own pocket for the item or
service. We are not legally required to accept any other request
for a restriction, but we will consider your request. If we do
accept it, we will comply with your request, except if you
need emergency treatment. Your request must be in writing.
To submit a request, please contact the Medical Records
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice. You may ask us to
give you a copy of this Notice at any time. Even if you have agreed to
receive this Notice electronically, you are still entitled to a paper copy
of this Notice.
If you believe your privacy rights have been violated, or you disagree
with a decision we made about access to your records, you may
contact our Privacy Officer (listed below) or you may contact our
Privacy Hotline, which operates 24-hours-a-day, seven days a week
at 1-800-299-7991. You may also send a written complaint to the
U.S. Department of Health and Human Services, Office of Civil
Rights. Our Privacy Officer can provide you with the address. You
will not be penalized for filing a complaint.
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If you have any questions about this Notice,
please contact our Privacy Officer by using
the information provided below.
Privacy Officer c/o Compliance Dept.
Greater Baltimore Medical Center
6701 North Charles Street
Baltimore, Maryland 21204
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6701 North Charles street
Baltimore, mD 21204
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